Pathology Flashcards by Jamie Craig

what is osteoporosis

reduced bone density and increased porosity

less than 2.5 SD below peak mean value of young adults of same race and sex

How well did you know this?

Not at all

Perfectly

what is osteopenia

intermediate osteoporosis where <1-2.5 SD below peak mean value of young adults same sex and race

How well did you know this?

Not at all

Perfectly

true/false - bone density loss is physiological?

true - osteoblastic activity begins to decrease around 30

How well did you know this?

Not at all

Perfectly

why is osteoporosis more common in females

post menopause has less protective oestrogen so there is increased osteoclastic activity

How well did you know this?

Not at all

Perfectly

causes of postmenopause primary osteoporosis and types of fracture

early menopause 
smoking 
lack exercise 
poor diet 
colles fracture and vertebral insufficiency

How well did you know this?

Not at all

Perfectly

causes of osteoporosis of old age and types of fracture

reduced vitamin D
chronic disease
inactivity
femoral neck fracture and vertebral fracture

How well did you know this?

Not at all

Perfectly

causes of secondary osteoporosis

steroid use 
chronic disease
alcohol abuse 
malnutrition 
hyperthyroidism/hyperparathyroidism

How well did you know this?

Not at all

Perfectly

what is the purpose of bisphosphonates

reduce osteoclastic absorption

How well did you know this?

Not at all

Perfectly

what is zoledronic acid

IV annual bisphosphonate

How well did you know this?

Not at all

Perfectly

action of desunomab?

reduces osteoclastic resorption

How well did you know this?

Not at all

Perfectly

action of strontium in osteoporosis

increases osteoblast replication and reduces resorption

How well did you know this?

Not at all

Perfectly

true/false - HRT is the best first line management for post menopause osteoporosis

false - bisphosphonates are as HRT has raised risk of breast and endometrial cancer as well as DVT

How well did you know this?

Not at all

Perfectly

what is osteomalacia?

qualitative defect of bone leading to abnormal softening due to deficient mineralisation of calcium and phosphorus

How well did you know this?

Not at all

Perfectly

causes of osteomalacia

inadequate sunlight exposure 
malabsorption 
malnutrition 
vitamin D resistance 
chronic kidney disease
long term anticonvulsant use

How well did you know this?

Not at all

Perfectly

symptoms of hypocalcaemia

parasthesiae 
muscle cramp
irritable 
fatigue 
seizure 
brittle nails

How well did you know this?

Not at all

Perfectly

what would you see on biochemistry with osteomalacia

low serum Ca and phos

high alk phos

How well did you know this?

Not at all

Perfectly

what would you see on x rays of osteomalacia

pseudofracture of pubic rami, prox femora, ulna, ribs

How well did you know this?

Not at all

Perfectly

causes of primary hyperparathyroidism

benign adenoma
malignant neoplasia
hyperplasia

How well did you know this?

Not at all

Perfectly

symptoms of hyperparathyroidism

stones 
bones 
groans 
moans 
thrones 
psychiatric overtones

How well did you know this?

Not at all

Perfectly

what is secondary hyperparathyroidism caused by

hypocalcaemia - causes overproduction of PTH

How well did you know this?

Not at all

Perfectly

most common benign bone tumour/

osteochondroma

How well did you know this?

Not at all

Perfectly

how does osteochondroma appear?

bony outgrowth with cartilagenous cap

How well did you know this?

Not at all

Perfectly

true/false - there is a 2% chance of malignant transformation with osteochondroma

false - it is <1%

How well did you know this?

Not at all

Perfectly

what is enchondroma and how does it appear

intramedullary and metaphyseal cartilagenous tumour by failed enchondral ossification
lucent and partly sclerotic

what bones is enchondroma more common in

femur, humerous, tibia, small bones hands and feet

what is an aneurismal bone cyst and what bones is it more common in

lots of chambers filled with blood/serum due to arterovenous malformation long bones, flat bones, vertebra

what is a simple bone cyst and where may it be found

cavity filled cyst in bone proximal humerous or femur in metaphysis

true/false - simple bone cysts and aneurismal bone cysts both cause pathological fracture

true

what is a giant cell tumour and in what bones may it be found

benign tumour involving epiphysis extending to subchondral bone knee and distal radius but also pelvis, spine and long bones

true/false - giant cell tumour can metastasise to lung

true - but it is still benign

what is fibrous dysplasia

genetic mutation in adolescents where there is lesions of fibrous tissue and immature bone

extensive fibrous dysplasia of the femur may cause ___

shepherds crook deformity

describe how an osteoid osteoma appears

immature bone surrounded by sclerotic halo

in what bones is an osteoid osteoma more common

proximal femur, diaphysis long bones and vertebrae

how would a malignant lesion appear on x ray

cortical destruction periosteal reaction new bone formation extension into soft tissue

what bones does osteosarcoma affect and how does it spread

knee, proximal femur, proximal humerous, pelvis | haematogenous

true/false - osteosarcoma is responsive to adjuvant therapy

true

what age group does chondrosarcoma affect, what bones does it affect, what is it responsive to, fast or slow to metastasise

older age of around 45 pelvis or proximal femur not responsive to radiotherapy or adjuvant slow to metastasise

fibrosarcoma is more commmon in who?

fibrous dysplasia, pagets, post radiation

what is ewings sarcoma, what age, what does it respond to

malignant tumour of primitive cells in marrow 10-20 chemo and radiotherapy

surgery for primary malignant bone tumours involves resection with what cm margin

3-4 cm

metastatic breast cancer is blastic/lytic and survival is?

blastic or lytic | 24 months

metastatic lung cancer is blastic/lytic and survival is

lytic | 6 months

metastatic prostate cancer is blastic/lytic and survival is

sclerotic (blastic) | 45% survive 1 year

metastatic renal cancer is blastic/lytic and survival is

lytic vascular blow out that can bleed if only 1 with a resectable primary tumour then may be cured if not 12-18 months

features of benign soft tissue tumour

``` small size well defined translucent regression in size cystic fluid filled soft lesion ```

features of malignant soft tissue neoplasm

``` quick growth systemic symptoms solid lesion large lesions ill defined irregular surface lymphadenopathy ```

what is a ganglion cyst

herniation of weak portion of synovial joint capsule or tendon sheath

what are the causes of a ganglion cyst and how may it appear

developmental or due to underlying joint damage/arthritis | transilluminate, firm, well defined

what is a bursa

small fluid filled sac lined by synovium around joint to prevent friction

what is bursitis

inflammation of bursa after repeated pressure

true/false - abscesses resolve with antibiotics

false - you need to drain them

what is avascular necrosis and what bones does it affect

ischaemic necrosis of bone | femoral head/condyles, proximal humerous, talar neck, scaphoid

risk factors for avascular necrosis

``` idiopathic alcohol use steroid use primary hyperlipidaemia thrombophilia sickle cell disease antiphospholipid syndrome decompression sickness ```

what follows avascular necrosis

secondary OA

primary cancer risk factors

idiopathic previous radiotherapy pagets, fibrous dysplasia, multiple echondromas li fraumeni, familial retinoblastoma

red flags for primary bone malignancy

``` pain not with movement worse at night swelling/erythema palpable mass fracture systemic symptoms age ```

when would you see a tumour on x ray

when >50% cortical bone destroyed so get a bone scan, CT, MRI if suspicious

common sites of secondary bone cancer?

BLT with kosher pickle | Breast, lung, thyroid, kidney, prostate